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Marijuana continues to be the most highly abused drug in America. The arguments for and against the legalization of marijuana continue to escalate. This piece is not intended to set the stage for a legalization debate about marijuana. Instead, I want caution practitioners whose patients under their care test positive for marijuana. Marijuana use is still forbidden by Federal law and patients who self-medicate or abuse marijuana should not be prescribed controlled substances.

Unfortunately, many physicians are often faced with the dilemma of whether or not to prescribe controlled substances to patients who drug test positive for marijuana. This is particularly the case in states that have modified state laws to legalize marijuana. These changes in state law do not change the Federal guidelines that physicians must follow. As a former career DEA agent, I remind physicians that marijuana is still an illegal Schedule I controlled substance with no accepted medical use in the U.S. The fact remains that all state laws have Federal oversight, as stated in the Supremacy Clause of the Constitution. “The Supremacy Clause is a clause within Article VI of the U.S. Constitution which dictates that federal law is the supreme law of the land. Under the doctrine of preemption, which is based on the Supremacy Clause, federal law preempts state law, even when the laws conflict.”(1) we get more info on Buy Weed Online.

When a physician becomes aware that a patient is using marijuana, alternate methods of therapy should be implemented other than prescribing controlled substances. Physicians should also take steps to refer the patient for treatment and cessation if any illegal drug use is revealed, including marijuana. Physicians should also keep in mind that the marijuana produced today is much more potent than the past and using high potency marijuana in conjunction with controlled substances is not safe for patients.

Is there such a thing as FDA approved medical marijuana? There are two FDA approved drugs in the U.S. containing a synthetic analogue of THC (tetrahydrocannabinol), which is the principal chemical (cannabinoid) responsible for marijuana’s psychoactive effects. A synthetic version of THC is contained in the FDA approved drugs Marinol (Schedule III) and Cesamet (Schedule II) which are prescribed to treat nausea for cancer patients undergoing chemotherapy. Marinol is also prescribed to stimulate the appetite of cancer and anorexia patients (2). The FDA is currently overseeing trials being conducted on Epidiolex (3), a drug manufactured by GW Pharmaceuticals and developed to reduce convulsive seizures in children. The drug contains cannabinoids from marijuana, referred to as cannabidiol or CBD, which does not contain the psychoactive properties of traditional marijuana and does not produce a high. If this drug receives FDA approval, it would make history being the first approved drug containing CBD in the U.S.

Marijuana has been used as a source of medicine for centuries – a common medicinal plant for the ancients. Even as technology became part of how we live, it was considered a viable treatment for many ailments. However, in 1923, the Canadian government banned marijuana. Although marijuana cigarettes were seized in 1932, nine years after the law passed, it took fourteen years for the first charge for marijuana possession to be laid against an individual.

In 1961, the United Nations signed an international treaty known as the Single Convention on Narcotic Drugs, which introduced the four Schedules of controlled substances. Marijuana officially became an internationally controlled drug, classified as a schedule IV (most restrictive).

Also included in the treaty is a requirement for the member nations to establish government agencies in order to control cultivation. As well, the requirements include criminalization of all processes of a scheduled drug, including cultivation, production, preparation, possession, sale, delivery, exportation, etc. Canada signed the treaty with Health Canada as its government agency.

Due to its medical applications, many have tried to get marijuana removed from the schedule IV classification or from the schedules all together. However, because cannabis was specifically mentioned in the 1961 Convention, modification would need a majority vote from the Commissions’ members.

Canada’s Changing Medicinal Marijuana Laws

The wording of the Convention seems clear; nations who sign the treaty must treat marijuana as a Schedule IV drug with the appropriate punishment. However, several articles of the treaty include provisions for the medical and scientific use of controlled substances. In 1998, Cannabis Control Policy: A Discussion Paper was made public. Written in 1979 by the Department of National Health and Welfare, Cannabis Control Policy summarized Canada’s obligations:

“In summary, there is considerable constructive latitude in those provisions of the international drug conventions which obligate Canada to make certain forms of cannabis-related conduct punishable offences. It is submitted that these obligations relate only to behaviours associated with illicit trafficking, and that even if Canada should elect to continue criminalizing consumption-oriented conduct, it is not required to convict or punish persons who have committed these offences.

Cannabis is not only the most abused illicit drug in the United States (Gold, Frost-Pineda, & Jacobs, 2004; NIDA, 2010) it is in fact the most abused illegal drug worldwide (UNODC, 2010). In the United States it is a schedule-I substance which means that it is legally considered as having no medical use and it is highly addictive (US DEA, 2010). Doweiko (2009) explains that not all cannabis has abuse potential. He therefore suggests using the common terminology marijuana when referring to cannabis with abuse potential. For the sake of clarity this terminology is used in this paper as well.

Today, marijuana is at the forefront of international controversy debating the appropriateness of its widespread illegal status. In many Union states it has become legalized for medical purposes. This trend is known as “medical marijuana” and is strongly applauded by advocates while simultaneously loathed harshly by opponents (Dubner, 2007; Nakay, 2007; Van Tuyl, 2007). It is in this context that it was decided to choose the topic of the physical and pharmacological effects of marijuana for the basis of this research article.

What is marijuana?

Marijuana is a plant more correctly called cannabis sativa. As mentioned, some cannabis sativa plants do not have abuse potential and are called hemp. Hemp is used widely for various fiber products including newspaper and artist’s canvas. Cannabis sativa with abuse potential is what we call marijuana (Doweiko, 2009). It is interesting to note that although widely studies for many years, there is a lot that researchers still do not know about marijuana. Neuroscientists and biologists know what the effects of marijuana are but they still do not fully understand why (Hazelden, 2005).

Deweiko (2009), Gold, Frost-Pineda, & Jacobs (2004) point out that of approximately four hundred known chemicals found in the cannabis plants, researchers know of over sixty that are thought to have psychoactive effects on the human brain. The most well known and potent of these is â-9-tetrahydrocannabinol, or THC. Like Hazelden (2005), Deweiko states that while we know many of the neurophysical effects of THC, the reasons THC produces these effects are unclear.

Neurobiology:

As a psychoactive substance, THC directly affects the central nervous system (CNS). It affects a massive range of neurotransmitters and catalyzes other biochemical and enzymatic activity as well. The CNS is stimulated when the THC activates specific neuroreceptors in the brain causing the various physical and emotional reactions that will be expounded on more specifically further on. The only substances that can activate neurotransmitters are substances that mimic chemicals that the brain produces naturally. The fact that THC stimulates brain function teaches scientists that the brain has natural cannabinoid receptors. It is still unclear why humans have natural cannabinoid receptors and how they work (Hazelden, 2005; Martin, 2004). What we do know is that marijuana will stimulate cannabinoid receptors up to twenty times more actively than any of the body’s natural neurotransmitters ever could (Doweiko, 2009).

Perhaps the biggest mystery of all is the relationship between THC and the neurotransmitter serotonin. Serotonin receptors are among the most stimulated by all psychoactive drugs, but most specifically alcohol and nicotine. Independent of marijuana’s relationship with the chemical, serotonin is already a little understood neurochemical and its supposed neuroscientific roles of functioning and purpose are still mostly hypothetical (Schuckit & Tapert, 2004). What neuroscientists have found definitively is that marijuana smokers have very high levels of serotonin activity (Hazelden, 2005). I would hypothesize that it may be this relationship between THC and serotonin that explains the “marijuana maintenance program” of achieving abstinence from alcohol and allows marijuana smokers to avoid painful withdrawal symptoms and avoid cravings from alcohol. The efficacy of “marijuana maintenance” for aiding alcohol abstinence is not scientific but is a phenomenon I have personally witnessed with numerous clients.